Maryland Health Benefit Exchange

Public Comments Form

The Maryland Health Benefit Exchange (MHBE) is seeking comments from the public on the following key policy area:

  • Application Counselors

Please provide comments on this area and return this form via email to y end of day on 2/4/13.

Submitter’s Name / Organization (if applicable) / Email / Phone

Application Counselors

Centers for Medicare and Medicaid Services' (CMS) released a proposed rule (NPRM) on January 14, 2013 which requires the MHBE to certify a new category of consumer assistance personnel known as "application counselors." Pursuant to the NPRM an application counselor:

  • Must be certified by the MHBE;
  • May assist individuals with eligibility determinations and enrollment;
  • May have relationships with providers, carriers, and other organizations;
  • May not receive funding from the Exchange; and
  • Shall comply with certain conflict-of-interest disclosure requirements.

Preliminary guidance from CCIIO indicates that for the most part, proposed requirements for application counselors may be incorporated into Maryland’s existing navigator program. However, MHBE navigators are not permitted to be paid by carriers, so the federal proposal on application counselor raises the question of whether further legislation is needed in Maryland with respect to carriers.

There is potential value in allowing carriers, in addition to providers and community-based organizations, to enroll individuals in Exchange QHPs. This additional enrollment track would help ensure that fewer people fall through the cracks. Also, it would increase the chances that people currently enrolled in health plans would be notified that they may be eligible for subsidies in the Exchange; and would receive assistance in determining eligibility and transitioning to an Exchange QHP. More generally, it would add to our capacity and boost our success in reaching everyone who may qualify for a federal subsidy or would otherwise benefit from enrolling in an Exchange QHP.

Policy Area / Question / Comments
Application Counselors / Could carriers fulfill the application counselor role through the existing producer authorization program in Sections 31-112 and 113 of the Insurance Article? Under this model, carriers would use "in-house" brokers who are authorized to sell QHPs in the Exchange. These authorized brokers would offer assistance to existing plan members to determine eligibility for subsidies and transition to an Exchange QHP if the member so desired. MHBE is now taking comment on requirements for broker participation in the Maryland Health Connection. For the purpose of this request for comment, please discuss whether specific decisions by the MHBE could obviate the need for a separate application counselor program.
If Maryland were to establish an application counselor program for carriers:
  • What requirements should apply for training?
  • What oversight mechanisms should be established?
  • What disclosures or other mechanisms should we use to ensure that people understand and can access other options that may be available in the Exchange beyond those that the application counselor, who is employed by the carrier, can offer?

Other comments – Please indicate any other comments you have regarding the application counselor program.

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Please return comments to by end of day on 2/4/13.